| Objective:At present,the application of the concept of Enhanced Recovery after Surgery(ERAS)in patients with gastric cancer is becoming more and more mature,but there are few studies on accelerated rehabilitation in patients with gastric cancer complicated with type 2 diabetes.The purpose of this study is to study the safety and efficacy of applying ERAS concept to patients with gastric cancer complicated with type 2 diabetes.Methods:Patients with gastric cancer complicated with type 2 diabetes who met the inclusion criteria in the Department of Gastrointestinal surgery of the affiliated Hospital of Jiangsu University from December 2019 to December 2020 were selected.A total of 52 patients were divided into ERAS group and control group according to their perioperative treatment measures,including 25 cases in ERAS group and 27 cases in control group.The related indexes of the two groups were observed,including the general condition of the patients before operation: age,BMI,nutritional risk,diabetes-related indicators,perioperative stress-related indicators: C-reactive protein(CRP),interleukin 6(IL-6),white blood cell count,perioperative nutrition-related indicators: albumin,prealbumin,hemoglobin levels,general data during operation:operation time,number of lymph node dissection,operative blood loss,perioperative blood glucose: intraoperative blood glucose,fasting blood glucose 7 days after operation,postoperative recovery: time of anal exhaust,time of drainage tube removal,postoperative hospital stay,complications and hospitalization expenses.Results:1.There were no statistical differences in age,gender,BMI,mode of operation,TNM tumor stage,nutritional status,course of diabetes and related conditions between the two groups.(P>0.05),and they were comparable.2.There was no significant difference in the preoperative inflammation indexes between the two groups of patients(P>0.05).The inflammation level of the two groups showed an upward trend and then a downward trend.The recovery time of inflammation indexes in the ERAS group was faster than that in the control group.The CRP level in the ERAS group was significantly different from that in the control group on the 5th and 7th day after operation(P<0.05);The level of IL-6 in the experimental group was lower than that in the control group on the 1st,3rd and 5th day after operation,and the difference was significant(P < 0.05);The leukocyte level in the ERAS group was lower than that in the control group,and it was the most significant on the first day after operation(P < 0.05).3.The preoperative nutritional indexes of the two groups were comparable,and there was no difference between the two groups(P > 0.05).At the same time,their albumin levels decreased on the first day after operation,and recovered from the third day after surgery.In the same period,compared with the control group,the albumin of the ERAS group remained at a higher level,and there was significant difference on the 5th and 7th day after operation(P < 0.05).The prealbumin level of the two groups decreased on the 3rd day after the operation and then showed an upward trend.On the1 st,5th and 7th day after operation,the prealbumin in the ERAS group was significantly higher than that in the control group(P < 0.05).The hemoglobin level in the ERAS group showed a downward trend,while that in the control group began to decline on the first day and began to rise on the third day after surgery.However,in the same time period,the hemoglobin in the control group was lower than that in the ERAS group,and there was statistical significance except on the 7th day after operation(P < 0.05).4.In ERAS group,the first exhaust time was earlier,the drainage tube was removed earlier and discharged earlier,the difference was significant(P < 0.05),but the cost of hospitalization is not much different(P>0.05).5.There was no obvious difference in the operation time and the number of lymph node dissection in each group.However,the intraoperative bleeding was less in the ERAS group,and the difference was significant(P < 0.05).6.The intraoperative blood glucose of the two groups showed an upward trend.During the same period,the blood glucose of the ERAS group was lower than that of the control group.The difference in blood glucose between 2 hours and 3 hours of operation was statistically significant(P<0.05).There was no significant difference in fasting blood glucose before surgery(P>0.05).The fasting blood glucose of all patients increased on the first day after operation,and then showed a downward trend and gradually stabilized.The level of blood glucose in the ERAS group was lower than that in the control group in each period,and there were significant differences on the 1st,3rd,and 6th days after operation(P<0.05).7.There was no significant difference in complications between the two groups(P > 0.05).Conclusion:The concept of Enhanced Recovery After Surgery is safe and effective when applied to patients with gastric cancer complicated with type 2 diabetes.It has significant effect in reducing stress response,improving postoperative nutrition,maintaining perioperative blood glucose stability and accelerating rehabilitation without increasing the incidence of postoperative complications. |
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